Medical Billing Forum

:-\ I recently took on some collection accounts for a physician in NYC. He has a significant backlog. But the thing is he has a great deal of claims that go as far back as 2006. How can I tell him "nicely" he will probably never see this money. I feel terrible for the practice. Some of the collection notes are very bad, if at all. Most are timely filing issues and even if I could prove timely filing, the appeal deadlines have long gone.

Not saying it's not possible.. but it's a long shot indeed, most likely will cost you more than you'll get back. All isn't lost thought, have him speak to his accountant about a loss write off. It depends on how he does his taxes (cash or accrual) but doctors can write off losses. I'm not an accountant and I won't pretend I understand the IRS.. like dealing with Pakistan for me.

Thanks for the reply Linda. I'm mostly getting the claims have been already purged or its way past timely filing, I'm having a hard time getting the CSRs to pull them back in the "system" for reconsideration.

I been mulling it over And I may try to submit a mass claim excel sheet if I can at least get a point of contact at the carriers.

I used to be a claims examiner at a few carriers.. they are all the same.. they are allowed to deny claims after the late filing deadlines and appeals will be considered at examiner discretion, HOWEVER.. i can tell you that you won't find any examiner who's going to pull purged files for claims that old. It involves a lot of work and time. Many claims back that far will either be purged and on microfilm and even in another location. Since they are so old the examiner will either be REQUIRED to deny them and on appeal they would go to the legal department if the value is substantial, even then they can still deny them. Not to also forget you have to remember that many of these may have also been paid, so your not just asking the carrier to go back that far and pay, but your asking them to manually calculate benefits on duplicate claims that were purged. I think you have about a 1 in 1000 shot in getting them to do this. JMHO

thanks I appreciate that. this was my intial thought process. they just wont be paid. out of 5 carriers today, I got one point of contact willing to take a look. if what you explained is right, he must be new. THANKS for that information. now I just need to make it "make sense" to the physician. It is a substantial amount out there. :-\

Here's what I would do if I were you.. I would do what the provider wants you to do. BUT.. CYA.... you need to be compensated for your time and efforts. Do a cost analysis based on what you would charge him for that time and the probability of collection. Bet he changes his mind ;) If not.. then do what he wants but you need to be compensated for your TIME.. NOT by claims value/collection.. biggest mistake made by billers.